Volar Ligament Research Articles

PANORAMIC REVIEW OF DISTAL RADIUS FRACTURES

Introduction: fractures affecting the distal radius are common, their incidence increases as life expectancy increases, leading to a larger population of individuals at risk of suffering these injuries. They are usually comminuted and intra-articular fractures that are outside the traditional eponymous classification. Objective: to detail current information related to distal radius fractures epidemiology, anatomy, mechanism of injury, clinical evaluation, classification, imaging evaluation, treatment and complications. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases and books, of which 19 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: distal radius fractures, radius anatomy, Colles fracture, Smith fracture, Barton fracture, treatment of distal radius fractures. Results: distal radius fractures account for about one sixth of all fractures treated in the emergency department, the incidence of distal radius fractures in the elderly correlates with the degree of osteopenia and increases with increasing age. The volar ligaments are stronger and provide greater stability to the radiocarpal joint compared to the dorsal ligaments. The most common mechanism is a fall on the hand in extension with the wrist in dorsiflexion. Currently, there is no consensus on the most optimal classification system for distal radius fractures. Conclusions: knowing correctly the whole picture of distal radius fractures allows to have a better performance when treating them. It is essential not to overlook in the physical examination the exploration of the ipsilateral elbow and shoulder to rule out the presence of associated injuries and to perform a complete evaluation to detect other possible injuries or life-threatening problems. Distal radius fractures can be treated conservatively or surgically depending on several factors, so classification is essential. There are multiple alternatives in surgical treatment, so the most appropriate one should be chosen for each case. The most common complications in this type of fracture are median nerve dysfunction, post-traumatic osteoarthritis, malunion or pseudoarthrosis and stiffness of the fingers, wrist and elbow. KEY WORDS: fracture, distal radius, Colles, Smith, Barton, treatment.

One-Year Outcomes of the Anatomical Front and Back Reconstruction for Scapholunate Dissociation

Anatomical front and back (ANAFAB) reconstruction addresses the critical volar and dorsal ligaments associated with scapholunate dissociation. We hypothesized that patients with symptomatic, chronic, late-stage scapholunate dissociation would demonstrate improvements in all radiographic parameters and patient-reported outcomes (PROMs) after ANAFAB reconstruction. From 2018 to 2021, 21 ANAFAB reconstructions performed by a single surgeon were followed prospectively, with 20 patients having a minimum follow-up of 12 months. In total, 17 men and four women were included, with an average age of 49 years. Three patients had modified Garcia-Elias stage 3 disease, eight stage 4, seven stage 5, and three stage 7. ANAFAB reconstruction of intrinsic and extrinsic ligament stabilizers was performed using a hybrid synthetic tape/tendon graft in a transosseous reconstruction. Pre- and postoperative radiographic parameters, grip, pinch strength, the Patient-Rated Wrist Evaluation, PROMIS Upper Extremity Function, and PROMIS Pain Interference outcome measures were compared. Mean follow-up was 17.9 months (range: 12-38). Radiographic parameters were improved at follow-up, including the following: scapholunate angle (mean 75.3° preoperatively to 69.2°), scapholunate gap (5.9-4.2 mm), dorsal scaphoid translation (1.2-0.2 mm), and radiolunate angle (13.5° to 1.8°). Mean Patient-Rated Wrist Evaluation scores for pain and function decreased from 40.6 before surgery to 10.4. We were unable to detect a significant difference in grip or pinch strength or radioscaphoid angle with the numbers tested. There were two minor complications, and two complications required re-operations, one patient who was converted to a proximal row carpectomy for failure of fixation, and one who required tenolysis/arthrolysis for arthrofibrosis. At 17.9-month average follow-up, radiographic and patient-reported outcome parameters improved after reconstruction of the critical dorsal and volar ligament stabilizers of the proximal carpal row with the ANAFAB technique. Therapeutic study IV.

Biomechanical Comparisons of Different Reconstructive Techniques for Scapholunate Dissociation: A Cadaveric Study.

There are many techniques for the treatment of chronic scapholunate dissociation. The three-ligament tenodesis (3LT) is used most widely, but reconstruction of the dorsal ligament alone may not provide sufficient stability. The Mark-Henry technique (MHT) compensates for the insufficient stability of 3LT by additional reconstruction of the volar ligament, but the procedure is complex. The SwiveLock technique (SWT), a recently introduced method, provides stability by using autologous tendons with synthetic tapes, but lacks long-term clinical results. To perform biomechanical comparisons of different reconstructive techniques for scapholunate dissociation using a controlled laboratory cadaveric model. Eleven fresh-frozen upper-extremity cadaveric specimens were prepared. The scapholunate distance, scaphoid rotation, and lunate rotation of the specimens were measured during continuous flexion-extension and ulnar-radial deviation movements. The data were collected using a wrist simulator with a linear guide rail system (tendon load/motion-controlled system) and a motion capture system. Results were compared in five conditions: (1) intact, (2) scapholunate dissociation, (3) SWT, (4) 3LT, and (5) MHT. Paired t-test was employed to compare the biomechanical characteristics of intact wrists to those of scapholunate dissociated wrists, and to those of wrists after each of the three reconstruction methods. SWT and MHT were effective solutions for reducing the widening in scapholunate distance. According to the radioscaphoid angle, all three reconstruction techniques were effective in addressing the flexion deformity of the scaphoid. According to the radiolunate angle, only SWT was effective in addressing the extension deformity of the lunate. In terms of scapholunate angle, only the results after SWT did not differ from those of the intact wrist. The SWT technique most effectively improved distraction intensity and rotational strength for the treatment of scapholunate dissociation. Taking into account the technical complexity of 3LT and MHT, SWT may be a more efficient technique to reduce operating time and minimize complications due to multiple incisions, transosseous tunnels, and complicated shuttling.

Arthroscopic Volar Capsuloligamentous Reattachment and Reinforcement to Bone.

Background: Injuries of the volar ligaments of the wrist are not uncommon, but their arthroscopic treatment presents a significant challenge. The objective of this paper is to introduce a technique for reattaching (in acute injuries) or reinforcing (in chronic injuries) various volar wrist ligaments to the bone, using standard wrist arthroscopic dorsal and volar portals. Methods: There are three common steps for all the arthroscopic volar capsuloligamentous reattachments or reinforcements Step 1 - Volar Portal Establishment: volar radial, volar ulnar and volar central portals are used depending on which structure needs to be reattached or reinforced. Step 2 - Anchor Placement: the anchor is positioned at the site where the ligament has been detached. Step 3 - Capsuloligamentous Suture and Knotting: a knot pusher is introduced inside the joint from the dorsal portal and advanced inside the volar portal where the threads of the anchor are located. The knot pusher is loaded with the threads and retrieved to the dorsal portal. A 16G Abbocath, loaded with a loop is used to pierce the volar ligaments. The loop of the Abbocath is captured from the dorsal portal and loaded with the threads. Both threads are taken to the volar portal and knotted after releasing the traction. This way the knot is placed out of the wrist and the ligaments are reattached or reinforced to the bone. Result: This technique has been used to reinforce and reattach the scapholunate and lunotriquetral ligaments and to reattach the radiocarpal ligaments and the Poirier space. Since this procedure has been performed in various conditions and in conjunction with other ligament treatments (such as perilunate injuries, carpal bone fractures, distal radius fractures, and reinforcement or reattachment of the dorsal portions of intrinsic ligaments), specific results are not presented. Conclusions: The described technique enables the reattachment and reinforcement of most volar ligaments to the bone using standard wrist arthroscopic portals. It can be performed in conjunction with the treatment of the dorsal portion of intrinsic ligaments or other wrist injuries.

Dumontier group 2 radiocarpal fracture-dislocation: The results of open reduction and fixation without volar ligament repair

IntroductionThe radiocarpal fracture-dislocations are a spectrum of severe injury involving both the bony and ligamentous structures that stabilise the wrist joint. The aim of this study was to analyse the outcome of open reduction and fixation without volar ligament repair for Dumontier group 2 radiocarpal fracture-dislocation and to evaluate the incidence and clinical relevance of ulnar translation and advanced osteoarthritis. Patients and methodsWe retrospectively reviewed 22 patients with Dumontier group 2 radiocarpal fracture-dislocation treated in our institute. Clinical and radiological outcomes were recorded. Postoperative visual analogue scale (VAS) score for pain, Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Mayo modified wrist scores (MMWS) were collected. Furthermore, extension‒flexion and supination‒pronation arcs were collected by reviewing chart, either. We divided the patients into two groups according to the presence or absence of advanced osteoarthritis, and presented the differences in the pain, disability, wrist performance, and range of motion between the two groups. We performed the same comparison between the patients with and those without the ulnar translation of the carpus. ResultsThere were sixteen men and six women with a median age of 23 years (range, 20‒48 years). The median follow-up period was 33 months (range, 12–149 months). The median VAS, DASH and MMWS were 0 (range 0–2), 9.1 (range, 0–65.9) and 80 (range, 45–90), respectively. The median flexion‒extension and pronation‒supination arcs were 142.5° (range, 20°‒170°) and 147.5° (range, 70°‒175°), respectively. Ulnar translation was recognised in four patients and the development of advanced osteoarthritis was noted in 13 patients during the follow-up period. However, neither was highly correlated with functional outcomes. ConclusionThe current study postulated that ulnar translation might occur following treatment for Dumontier group 2 lesions, whereas injury was predominantly caused by rotational force. Therefore, radiocarpal instability should be recognized during the operation. However, the clinical relevance of ulnar translation and wrist osteoarthritis needs to be assessed in further comparison studies.

Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases.

Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.

OUTCOME ANALYSIS OF DISTAL RADIUS FRACTURES TREATED WITH K-WIRES VS CASTING

Background Distal radius fracture has long been treated by closed reduction and casting . Although casting sufces in a proportion of cases, it may fail to maintaining the reduction is usually a problem. Hence, in a majority of cases, with cast satisfactory reduction can lost resulting in a poor anatomical and in some cases functional outcome. Percutaneous K-Wire xation1-3 is a simple way of providing additional stability to immobilization in casting an unstable fracture of distal radius in which acceptable anatomical reduction is obtainable. The technique is simple, minimally invasive and inexpensive. It is much less intrusive than other methods such as external xation. Though it has its own set of complications e.g. pin tract infection, supercial radial neuropathy etc. It still forms an effective tool in the surgical armamentarium for treatment of distal radius fractures. The present study was conducted at the de Methods partment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2020 and 2021.Sixty patients who fullled inclusion criteria were taken up for study n=60. They were randomly divided into two groups with 30 members each belonging to casting and k-wire xation groups. In Results both treatment methods radial length, ulnar variance, radial angulation are restored to near normal but correction of dorsal tilt is not complete. This is because the fact that volar ligaments are stronger on distraction before relatively 'Z' oriented dorsal ligaments. So, on distraction volar cortex is brought out to length before dorsal cortex preventing full correction of dorsal tilt.Cast immobilization alone could not maintain reduction in unstable fractures resulting in poor anatomical outcome.53% patients of cast immobilization had moderate to severe deformity, compared with only 11.76% patients of K wire and casting group having moderate deformity. At the end of 12 weeks, functional outcomes in the studied both types were almost similar with no signicant difference in DASH scores. At the end of the study, we concluded that Conclusion both the techniques of managements K wire xation and casting and closed reduction and casting gives near equal results in terms of functional outcome. Better anatomical reduction and maintenance of reduction can be expected with K wire xation and casting group.

Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous internal fixation for the treatment of distal radius Fernandez type Ⅳ fractures

To explore clinical effect of treatment for distal radius Fernandez type Ⅳ fractures by wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation. From January 2018 to December 2019, 11 patients distal radius Fernandez type Ⅳ fractures treated with wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation, including 8 males and 3 females, aged from 23 to 42 years old. The fracture were all calssified to type Ⅳ according to Fernandez classification. Postoperative fracture healing, activity of wrist joint and recovery of wrist joint were observed, postoperative visual analogue scale(VAS) at 12 months was used to evaluate pain of wrist joint, and Cooney wrist score scale was used to evaluate clinical effects. All the 11 patients were followed up from 12 to 13 months, and fractures were healed well for 4 to 6 months. Postoperative VAS at 12 months ranged from 0 to 3, palm tilt angle ranged from 0° to 15 °, ulnar drift angle ranged from 15° to 21°, wrist flexion and extension motion ranged from 110° to 162°, forearm rotation motion ranged from 165° to 178°. Cooney wrist joint comprehensive score ranged from 70 to 95 points, and 8 patients got excellent result, 2 good, and 1 fair. No osteoarthritis and complications occurred. Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation for the treatment of Fernandez Ⅳ distal radius fractures could recevie effective fixation, and could receive satisfied clinical effect with system function exercise postoperative.

Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures.

Background Volar ulnar corner fractures are a subset of distal radius fractures that can have disastrous complications if not appreciated, recognized, and appropriately managed. The volar ulnar corner of the distal radius is the "critical corner" between the radial calcar, distal ulna, and carpus and is responsible for maintaining stability while transferring force from the carpus. Description Force transmitted from the carpus to the radial diaphysis is via the radial calcar. A breach in this area of thickened cortex may result in the collapse of the critical corner. The watershed ridge (line) is clinically important in these injuries and must be appreciated during planning and fixation. Fractures distal to the watershed ridge create an added level of complexity and associated injuries must be managed. An osteoligamentous unit comprises bone-ligament-bone construct. Volar ulnar corner fractures represent a spectrum of osteoligamentous injuries each with their own associated injuries and management techniques. The force from the initial volar ulnar corner fracture can propagate along the volar rim resulting in an occult volar ligament injury, which is a larger zone of injury than appreciated on radiographs and computerized tomography scan. These lesions are often underestimated at the time of fixation, and for this reason, we refer to them as sleeper lesions. Unfortunately, they may become unmasked once the wrist is mobilized or loaded. Conclusions Management requires careful planning due to a relatively high rate of complications after fixation. A systematic approach to plate positioning, utilizing several fixation techniques beyond the standard volar rim plate, and utilizing fluoroscopy and/or arthroscopy is the key strategy to assist with management. In this article, we take a different view of the volar ulnar corner anatomy, applied anatomy of the region, associated injuries, and management options.

Proximal avulsion of the extrinsic volar radiocarpal ligaments following radiocarpal dislocation

Proximal avulsion of the extrinsic volar radiocarpal ligaments following radiocarpal dislocation

Comparative Analysis of 3 Techniques of Scapholunate Reconstruction for Dorsal Intercalated Segment Instability

The combination of scaphoid rotatory subluxation, dorsal intercalated segment instability, and dorsal scaphoid translation (DST) constitutes stage 5 scapholunate dissociation in the modified classification system of Garcia-Elias. The purpose of this study was to compare the static radiographic outcomes of reduction and association of the scaphoid and lunate (RASL), three-ligament tenodesis (TLT), and anatomic front and back (ANAFAB) reconstructions for stage 5 scaphoid and lunate malrotation and translation. Stage 5 scapholunate dissociation was created in 15 fresh-frozen specimens by cutting the scapholunate interosseous ligament, long radiolunate ligament, dorsal intercarpal ligament, and scaphotrapeziotrapezoid ligament complex. Specimens were randomized to receive 1 of the 3 reconstructive techniques. Radiolunate angle (RLA), scapholunate angle, scapholunate gap, and DST were measured in static fluoroscopic posteroanterior and lateral views in 3 conditions: baseline, injured, and reconstructed. Reduction and association of the scaphoid and lunate showed an improved correction of scapholunate gap compared with TLT and ANAFAB. Anatomic front and back demonstrated an improved correction in RLA and scapholunate angle compared with RASL but not TLT. When the reconstruction was compared with baseline, there was a persistent lunate extension for TLT (RLA and scapholunate angle) and RASL (RLA); however, no significant difference in any parameter was found with ANAFAB. Anatomic front and back significantly improved DST, whereas TLT and RASL did not. In this cadaveric model of scapholunate dissociation with dorsal intercalated segment instability and DST, each of the 3 repairs had different effects on carpal posture and alignment. While only RASL statistically improved scapholunate gap, only ANAFAB significantly improved DST. Both TLT and RASL improved radiographic parameters; however, each had a persistent increase in the lunate extension following reconstruction. It may be prudent to consider different reconstructive techniques for different stages of scapholunate instability. Anatomic front and back, a repair that addresses both dorsal and volar ligament stabilizers, provides improved reduction of dorsal intercalated segment instability and DST in stage 5 scapholunate dissociation.

The triangular fibrocartilage complex on high-resolution 3\xa0T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

ObjectiveThe objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents.Materials and methodsProspectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI).ResultsThe cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components.ConclusionMRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

Operative Treatment for First Carpometacarpal Arthritis ( Systematic Review )

The anatomy of the thumb carpometacarpal (CMC) joint, as well as the force transmitted through it, makes it extremely susceptible to osteoarthritis (OA). The thumb CMC joint has been reported as the most painful joint when compared to other hand joints affected by OA. to provide an updated, systematic review of surgical management and outcomes of the most commonly used surgical procedures to treat CMC joint OA presented in literature. we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till January, 36 studies were included. the overall effect estimates showed that the rate of pain at rest after metacarpal osteotomy was 25.1% (95% CI 9.6 – 40.7%); while the rate of satisfaction after metacarpal osteotomy was 48.1% (95% CI 10.5 – 85.7%). The overall effect estimates showed that the rate of normal handgrip after metacarpal osteotomy was 87.1% (95% CI 79.2 – 95%). the overall effect estimates showed that the rate of pain at rest after Volar ligament reconstruction was18.4% (95% CI 11.5 – 25.4%) and the rate of satisfaction was 81.6% (95% CI 74.6 – 88.5%). no surgical procedure appears to be definitely superior to another for the management of first carpometacarpal arthritis in terms of pain, physical function, patient global assessment, range of motion, or strength. Nevertheless, participants who had trapeziectomy had fewer complications than those who had the other commonly used procedures analyzed in the review.

Volar Radiocarpal Ligament Repair with Suture Anchors for Radiocarpal Fracture Dislocations: Case Series.

Background Radiocarpal fracture dislocations cause significant intraarticular disruption and instability difficult to treat with traditional plating methods. Description of Technique Suture anchor fixation of the volar radiocarpal ligaments through an extended carpal tunnel approach, supplemented with radial styloid fixation, restores stability to the radiocarpal joint. Patients and Methods We performed a retrospective review of 14 consecutive radiocarpal fracture-dislocations (RCFDs) treated at two-level one trauma center from 2011 to 2015. In all cases, the volar radiocarpal ligaments were repaired to the distal radius with suture anchors. Results We reviewed 14 Dumontier Group 2 RCFDs in 14 patients (10 males, four females) with an average age of 39 years (range 22-53 years). Final follow-up averaged 288 days (range 7-1,364 days). Surgeons performed volar ligament repair with suture anchors in all cases, radial styloid fixation in 79% (11/14), and dorsal plate fixation in 29% (4/14). Eight of 14 patients (57%) had a "flipped" volar lip fragment of the distal radius. Three patients had forearm compartment syndrome and two patients had acute carpal tunnel syndrome. No patients experienced radiocarpal subluxation after volar ligament repair. Conclusion No recurrent subluxation or dislocation occurred after primary repair of the volar radiocarpal ligaments using suture anchors in this series of radiocarpal fracture dislocations. Volar radiocarpal ligament repair also addressed the "flipped" volar rim fragment that could not be addressed through a dorsal approach alone. Level of Evidence : This is a Level IV, case series therapeutic study.

Radioulnar joint reconstruction: a novel surgical technique and biomechanical assessment for chronic instability

PurposeThis study aims to describe and biomechanically evaluate a novel technique using a strip of the flexor carpi ulnaris tendon for distal radioulnar joint reconstruction.MethodsSurgical technique was thoroughly detailed, and a cadaveric biomechanical test was conducted to evaluate sagittal plane stability. Pronosupination range of motion was measured before and after the procedure. Dorsal and volar translation resistances were checked in three situations: with the uninjured triangular fibrocartilage complex, after its complete resection and after the surgical procedure.ResultsFor distal radioulnar joint translation, higher values were found both in dorsal and volar translation in situations with an injured triangular fibrocartilage complex, with means equal to 25.4 mm (SD: 9.4 mm) and 26.1 mm (SD: 8.0 mm), respectively. For intact triangular fibrocartilage complex, both dorsal and volar translations averages were 3.4 mm (SD: 0.9 mm) and 4.5 mm (SD: 1.8 mm), respectively. Finally, when evaluating dorsal and volar translations after surgical reconstruction, means were 6.3 mm (SD: 1.3 mm) and 6.8 mm (SD: 0.9 mm), respectively. Regarding supination and pronation range of motion, which ranged from 57.9 to 63.4o, there were no differences in mean and median measures, when the cadavers with intact and reconstructed triangular fibrocartilage complex were compared (p > 0.05).ConclusionPromising mechanical evaluations encourage us to hypothesize that the technique effectively reconstructs the dorsal and volar radioulnar ligaments, preserving pronosupination and maintaining the physiological characteristics of the wrist joint. Clinical comparative studies are still necessary to fully validate this procedure.Level of evidenceTherapeutic - Level V.

Ulnar collateral ligament injuries of the first metacarpophalangeal joint: prevalence of associated injuries on radiographs and MRI

PurposeTo evaluate the prevalence of associated findings at the first metacarpophalangeal joint on radiographs and MRI following acute ulnar collateral ligament (UCL) injuries.Materials and methodsThis retrospective study included 25 patients with an injury of the UCL at MRI. Presence of associated injuries to the volar ligaments (checkrein and phalangoglenoid ligaments and volar plate) was assessed on radiographs and MRI independently by two musculoskeletal radiologists. Wilcoxon signed-rank test was used to compare frequencies of injuries between both modalities (p < 0.05). Interreader variability was calculated.ResultsComplete tears of the UCL (48%/60%, reader 1/2) were more common than partial tears (24%/16%) on MRI. Dislocation of the UCL ≥ 3 mm was detected in 40%/56% on MRI. UCL avulsion fractures were more frequently seen on MRI (28%) compared with radiographs (12%) for reader 1. Associated avulsion injuries of the phalangoglenoid ligament were evident in 12%/8% on radiographs and in 80%/76% on MRI. Almost all patients (100%/79%) with a dislocated UCL tear showed a concomitant volar ligament injury; and even two-thirds (66%/72%) of the non-displaced UCL tears had an injury to the volar ligaments. Interreader agreement was moderate to excellent (κ = 0.60–1.0).ConclusionUCL tears are often associated with volar ligament injuries, even in lesser degrees of an UCL injury.

Study on the fracture morphology and imaging of distal radioulnar ligament of type C distal radius fracture

Objective To provide reference data for clinical and biomechanical research through drawing the fracture morphology of type C distal radius fracture and the length of distal radioulnar ligament by fracture mapping technology. Methods From January 2018 to December 2018, 59 cases of OTA/AO 23 C type distal radius fractures were treated in our hospital. Thirty wrist joints of 15 volunteers were used as healthy control group. After thin-layer CT scanning of the wrist joint, the three-dimensional reconstruction was performed by importing the Mimics medical software. The fracture line of the distal radius was introduced into the template after standardization, and the shape of the fracture line was obtained after fitting. The length of the distal radioulnar ligament was obtained by measuring the distance between the sigmoid notch and the base and recess of styloid process of ulna. Results On the radiocarpal joint surface, the fracture line was mainly concentrated around the lunate fossa demonstrated as cross; on the volar side, the fracture line was mainly concentrated around the watery flow line; on the dorsal side, the fracture line was concentrated around Lister's tubercle and scattered; in the area of sigmoid notch, the fracture line was concentrated in the middle 1/3 and dorsal 1/3 of sigmoid notch; in the area of styloid process of radius, it was seen that the styloid process of radius was relatively complete, and the fracture line was distributed under the styloid process of radius. There was no significant difference in the length of the four groups of ligaments, i.e. the volar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament, the volar deep distal radioulnar ligament and the dorsal deep distal radioulnar ligament among the subtypes (C1, C2, C3) of type C distal radius fracture (P>0.05); there was no significant difference between the groups and the healthy control group (n=30, P>0.05). When the fracture line was located in the volar 1/3 and dorsal 1/3 of the sigmoid notch, the length of the palmar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament and the dorsal deep distal radioulnar ligament were significantly different from that of the healthy control group (n=30, P<0.05). Conclusion The fracture pattern of type C distal radius can be visualized by fracture mapping technology. On the radiocarpal joint surface, the fracture line is concentrated around the lunate fossa; in the joint area of sigmoid notch, the fracture line is more concentrated in the middle 1/3 and the dorsal 1/3 of sigmoid notch. When the fracture line is distributed in the volar 1/3 and the dorsal 1/3 of sigmoid notch, it may lead to the risk of distal radioulnar ligament injury. Key words: Radius fractures; Biomechanics; Fracture mapping; Distal radioulnar ligament

How Close Are the Volar Wrist Ligaments to the Distal Edge of the Pronator Quadratus? An Anatomical Study.

Background: This cadaveric study defines the interval distance between the proximal insertion of the volar wrist ligaments and the distal edge of the pronator quadratus on the distal radius. It is important to be aware of this distance during surgical dissection for placement of volar locking plates for wrist fractures. Disruption of the volar wrist ligament insertion may have adverse biomechanical consequences such as carpal instability, which can lead to pain and eventually wrist arthritis. Methods: Thirteen cadaveric wrists were dissected using the trans-flexor carpi radialis volar approach to identify relevant anatomy. The distance between the distal border of the pronator quadratus and the most proximal insertion of the volar wrist ligaments was measured. Results: The average distance between the pronator quadratus and the proximal insertion of the volar wrist ligaments was 5 mm, with a standard deviation of 2 mm. Conclusions: The volar wrist ligaments insert quite near the distal end of the pronator quadratus. Surgeons should be cognizant of the proximity of the volar wrist ligaments and be judicious with subperiosteal stripping of the distal fragment during volar plating procedures.

Madelung’s deformity: distal radioulnar joint re-optimization

Background Although Madelung’s deformity (MD) is believed to be a rare congenital anomaly of the wrist, the symptoms do not manifest till late childhood. It is caused by asymmetric growth at the distal radial physis secondary to premature and partial volar–ulnar-sided arrest, and a thickened radiolunate volar ligament (Vickers ligament) that creates a tether across that physis segment, restricting growth across it. Radial growth disturbance causes the distal radius to deform in the coronal (increasing radial inclination) and sagittal (increasing volar tilt) planes, and eventually lead to a progressive, three-dimensional wrist deformity including radiocarpal and distal radioulnar joint (DRUJ) malalignment. Various techniques for the surgical management of MD have been described, but clear evidence to support the use of any single approach is lacking. Patients and methods Eight wrists in six patients with MD were included in this study. All patients underwent combined radial biplane closing wedge osteotomy above Vickers’ ligament radial origin, which allowed for three-dimensional correction of the deformity and reposing of the ligament, making it easy to achieve more congruity of the DRUJ, and temporary fixation with dual percutaneous K-wires of the DRUJ in the achieved re-optimized new components’ correlation. Results At 22 months of an average follow-up, patients were satisfied with the appearance of their wrists and forearms. The range of active pain-free wrist movements improved notably in supination and extension, correction toward normal values for the mean measurements of radiographic parameters was reported, and the DRUJ was congruent with sustained improvement of its mean gap distance at the latest follow-up radiographs. Conclusion This technique seems to be safe and can reliably restore hand–forearm alignment with respect to DRUJ re-optimization through the redesigned distal radial alignment in both coronal and sagittal planes, and improve joint congruity.

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

Osteoarthritis of the thumb carpometacarpal joint is common, especially in postmenopausal women. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been introduced. Suspensionplasty combined with trapeziectomy has been introduced to prevent proximal subsidence of the first metacarpal. To prevent excessive release of periarticular capsuloligamentous tissues, resection of the proximal part of the trapezium, and the cosmetically unappealing bump, arthroscopic partial trapeziectomy has been used as a less-invasive treatment option. With advanced techniques and devices, arthroscopic suspensionplasty with the autograft can be performed; thus far, there have been no series reporting on arthroscopic treatment options for this common condition. The purpose of this article is to present a technique for arthroscopic-assisted suspensionplasty using the palmaris longus tendon to reinforce the graft–bone interface, based on the concept of the tension slide technique to treat thumb carpometacarpal osteoarthritis.